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Should we focus more on environmental health, rather than so much on healthcare?

(Introduction by Croakey)

As US President Donald Trump makes “rollback of environmental regulations one of his signature issues”, and Australia also appears set to cave to industry interests on proposed new vehicle emission regulations, a powerful call has been made for leaders to “recognise that environmental policy is health policy”.

Writing for The Conversation, Chelsey Kivland, Professor of Anthropology at Dartmouth College, and Anne Sosin, Program Manager of the Global Health Initiative Program at Dartmouth College, suggest health advocates need to be speaking up much more on environmental matters.

The recent history of Haiti, they say, is a reflection of the dangerous intersection of climate change, poverty and ill health, and “predictive of what is to come in the rest of the world”, illustrating the importance of the changing natural environment for health.

“Fixing healthcare systems while we undermine the environmental conditions for health are a textbook example of what Haitians describe as “lave men, swiyè atè” – washing your hands but drying them in the dirt,” they say.

Meanwhile, Croakey readers may be interested in this Netflix documentary, HardNOx, investigating the VW emissions scandal. A review in The Guardian says it “turns up new evidence, more shocking details about the scale of the deceit, the attempts to cover it up, and the unhealthy alliance between governments and car manufacturers that allowed it to happen in the first place.”

And beneath the article below, “Why climate change is worsening public health problems”, cross-published from The Conversation, is a useful explainer on climate change and public health by Professor Jonathan Patz@jonathanpatz – director of the Global Health Institute at the University of Wisconsin-Madison.


Chelsey Kivland and Anne Sosin write:

Dr Tedros Adhanom Ghebreyesus, head of the World Health Organization, recently announced: “All roads lead to universal health coverage.” Discussions for how to translate this vision into a road map for action is central to the agenda of the WHO’s executive board’s recent meeting in Geneva.

Yet focusing on access is not enough. The imperative for access must be paired with a frank acknowledgment that climate change is making communities around the world more vulnerable to ill health. A 2017 commission of The Lancet, a leading health research journal, tracked the effects of climate change on health and found evidence of harms “far worse that previously understood.”

Even as we move to close the access gap, a string of natural disasters in late 2017, including successive hurricanes and widespread forest fires, threaten to widen the vulnerability gap.

As a global health professional (Sosin) and a cultural anthropologist (Kivland), we have witnessed how the global exchange of health technology, expertise and aid has contributed to dramatic gains in the delivery of health care in Haiti and other settings, especially around infectious diseases. Yet climate change threatens to undermine the health gains in vulnerable communities across the globe.

As firsthand witnesses to sharp health disparities globally, we argue that world leaders need to insist that any health care strategy must address the social and environmental vulnerabilities driving poor health in the first place.

The health burden of climate change

Climate scientists argue that global warming is exacerbating extreme weather events. And natural disasters are often the source of health crises, particularly in fragile settings. Consider the case of Puerto Rico. The official death toll of the storm was estimated at 64; however, later reports have estimated that the disruption of health care services contributed to upwards of 1,052 deaths on the island.

Lagging recovery efforts have exposed how natural disasters deepen the relationship between socio-economic inequality and health disparity. In Puerto Rico, where poverty rates are double those of the poorest continental state, people already struggling with illnesses such as diabetes and kidney disease have seen their conditions worsen as the long-crumbling health care system is overwhelmed with patients and neglected by the mainland government.

The health impacts of the storms may persist even beyond the restoration of health services.

Hurricane Harvey exposed the toxic afterlife of disastrous storms. Storm damage to 40 industrial sites released chemical toxins linked to cellular damage, cancer and other long-term health problems. As The Lancet’s Commission on Pollution and Health found, air, water and soil pollution is now the leading environmental cause of death and disability, accounting for more than 9 million deaths annually. These numbers will only grow in the face of climate-induced disasters.

Restoring health care systems is vital for these communities, but it will merely treat the symptoms and not the causes of post-disaster illness. We believe that policymakers must address the link between environmental and health crises.

Haiti as case study

Men in Port-au-Prince, Haiti, collect water on Nov. 11, 2017. Years after Hurricane Matthew nearly devastated Haiti, its vulnerability only increases. Reuters/Martinez Casares

We have learned this lesson from our work in Haiti. Once a death sentence in rural Haiti, today HIV is largely controlled thanks to widespread access to antiretroviral therapy. The prevalence of the disease in pregnant women fell from 6 percent to just over 2 percent in the 10-year period from 1993 to 2003. Likewise, vaccines against cholera, introduced in 2015,have proven to be up to 90 percent effective against the disease.

However, even as vaccine coverage continues to grow, the population remains at risk for cholera and other emergent threats. Only 58 percent of the population has access to safe water and only 28 percent has access to basic sanitation. These conditions worsen in the wake of natural disasters. Hurricane Mathew in 2016 triggered spikes in cholera and other waterborne diseases, especially diarrhea, the second leading cause of death among children.

Hitting the one region of Haiti that had not yet been denuded of trees and vegetation, Hurricane Matthew seemed to complete the destruction of the country’s food systems.

Since the late 1980s, the erosion of waterways, loss of habitats and destruction of agricultural land have fueled the importation of cheap, processed foods. Rice and pasta have replaced a diet once rich in fruits, vegetables and whole grains. The high-sugar, low-nutrition foods contribute to the dual health burdens of obesity and under-nutrition.

These trends are ongoing, but they are exacerbated by the disastrous shocks of extreme weather events, which are made more likely by climate change. As Hurricane Matthew came ashore, it decimated fishing villages and tore through farming communities, killing livestock, uprooting crops and denuding backyard fruit trees. The United Nations estimated that 800,000 people suffered food shortages.

Closing the vulnerability gap

Haiti is often cast as behind the global curve. But as a reflection of the dangerous intersection of climate change, poverty and ill health, it is in fact predictive of what is to come in the rest of the world. Haiti teaches us that our own health is not bound up simply in the present decisions we make about health care systems but rather more broadly situated in the changing natural environment.

Closing the access gap has been a long battle and the gains cannot be underestimated. Yet the challenge ahead is even more daunting. Whereas increasing access has centered on extending health care technologies to underserved populations, closing the vulnerability gap will require approaches that extend beyond the health sector and national borders.

In the past year, the health care debate in the U.S. has centered on attempts to limit or expand access to care. Meanwhile, the Trump administration has left the Paris climate accord and unraveled environmental protections for national and transnational corporations – with little resistance from health advocates. We believe that leaders must recognize that environmental policy is health policy. Rollbacks of environmental regulations will cause far greater consequences on health, in the U.S. and globally, than any health care bill.

Fixing health care systems while we undermine the environmental conditions for health are a textbook example of what Haitians describe as “lave men, swiyè atè”—washing your hands but drying them in the dirt.

• Chelsey Kivland is Professor of Anthropology, at Dartmouth College, and Anne Sosin is Program Manager of the Global Health Initiative Program at Dartmouth College. Their article was first published in The Conversation.


Public health is being impacted by climate change via many pathways – from alterations in infectious disease transmission to water-source compromise, malnutrition, air pollution, and other factors. This talk includes recent analyses that show how mitigating global warming provides extensive health opportunities, as well as major savings in healthcare costs. Jonathan Patz, MD, MPH, is Professor & John P. Holton Chair in Health and the Environment at the University of Wisconsin-Madison, where he also directs the Global Health Institute. He co-chaired the health expert panel of the first Congressionally mandated US National Assessment on Climate Change and was a convening lead author for the international Millennium Ecosystem Assessment. For 14 years, Patz was a lead author for the United Nations Intergovernmental Panel on Climate Change (IPCC) – co-recipient of the 2007 Nobel Peace Prize. Patz is the author of nearly 100 peer-reviewed papers plus multiple reports, two co-edited textbooks and an encyclopedia on global environmental health. This talk was given at a TEDx event using the TED conference format but independently organized by a local community.

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Pregnancy and childbirth
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Acknowledgement
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Health in All Policies
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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
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Population Health Congress 2015
2016 conferences
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